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Appointment
Book an Appointment with us!
First Name
Last Name
Patient Gender
– Select –
Male
Female
Others
Patient Age
Phone no.
Have you previously attended our facility
Yes
No
If Yes, state on which condition and when?
Select Date / Time
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Categories
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Feminine Care
First Aid & Bandages
Health Care
Masculine Care
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Socials
Address
3164 N Delaware Rd Milan, Indiana(IN), 47031
Information
Hotline: +(84) 2500 888 33
support@example.com
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